N.Y. Comp. Codes R. & Regs. tit. 14, Appendices, app 106

NACC C-21

(Auth Reg § 2012.1)

STATE OF NEW YORK NARCOTIC ADDICTION CONTROL COMMISSION

N. A.C.C. NO. ________

N. Y.S.I.I.S. NO. ________

WARRANT FOR RETURN FROM AFTERCARE STATUS TO

TREATMENT CENTER

TO ANY NARCOTIC REHABILITATION OFFICER, NARCOTIC CORRECTION OFFICER, NARCOTIC PAROLE OFFICER, WARRANT OFFICER, OR OTHER PERSON AUTHORIZED TO RETURN ADDICTS TO TREATMENT CENTERS

Pursuant to the authority granted by Article 9 of the Mental Hygiene Law and the regulations of the Narcotic Addiction Control Commission, I hereby Order that ________, a certified narcotic addict placed upon aftercare supervision by the Narcotic Addiction Control Commission and remaining in the legal custody of the Commission be returned to the physical custody of the said Commission by arresting, detaining, and delivering the said certified addict to ________, a treatment center of the said Commission, or to any other treatment center otherwise designated by the Commission, and for so doing, this shall be your sufficient Warrant.

NEW YORK STATE NARCOTIC ADDICTION

CONTROL COMMISSION

Dated: ________, 19________ Per

____________

Authorized Signature

____________

Typed Signature

____________

Address

________

Notes

N.Y. Comp. Codes R. & Regs. tit. 14, Appendices, app 106